普美显肝胆期甜甜圈结节MRI表现联合DCE-MRI灌注定量参数评估肝细胞癌经肝动脉化疗栓塞疗效的价值

摘要/Abstract

摘要： 目的探究普美显肝胆期甜甜圈结节磁共振扫描(MRI)表现联合MRI动态增强扫描(DCE-MRI)灌注定量参数评估肝细胞癌(HCC)经肝动脉化疗栓塞(TACE)疗效的价值。方法回顾性分析2018年1月—2023年1月常州市第三人民医院收诊的86例行TACE治疗的HCC患者的病历资料。记录TACE治疗前普美显肝胆期甜甜圈结节MRI表现及DCE-MRI灌注定量参数[病灶最大层面血管通透性常数(Kt)、血液回流常数(Kep)、血管外细胞间隙容积百分比(Ve)]。TACE治疗后参考实体瘤评价标准1.1(RECIST 1.1)评估疗效,并分为稳定组、进展组。分析HCC患者TACE疗效的影响因素,评估普美显肝胆期甜甜圈结节MRI表现、DCE-MRI灌注定量参数对HCC患者TACE疗效的预测效能。结果 86例行TACE治疗的HCC患者中进展46例(53.49%),稳定40例(46.51%)。TACE治疗前,MRI肝胆期扫描结果显示,86例HCC患者中肝胆期甜甜圈结节表现35例(40.70%)且动脉期均呈高增强信号,低信号表现45例(52.33%),高信号表现6例(6.98%)。普美显肝胆期甜甜圈结节MRI表现预测TACE疗效的灵敏度为76.09%、特异度为100.00%、阳性预测值为100.00%、阴性预测值为78.43%。进展组、稳定组患者的△Kt分别为0.22±0.07、0.31±0.09,△Kep分别为0.57±0.12、0.39±0.10。进展组患者的△Kt低于稳定组,△Kep高于稳定组(P<0.05)。两组△Ve比较差异无统计学意义(P>0.05)。进展组患者的总胆红素(TBil)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)高于稳定组(P<0.05)。TBil、ALT、AST、△Kt、△Kep及普美显肝胆期甜甜圈结节表现是HCC进展的危险因素(P<0.05)。普美显肝胆期甜甜圈结节MRI表现、△Kt、△Kep单一及联合预测HCC进展的AUC分别为0.880、0.750、0.748、0.887。结论普美显肝胆期甜甜圈结节MRI表现与DCE-MRI灌注中Kt及Kep变化与HCC患者TACE的治疗反应性有关,可用于预测疗效。

关键词: 肝细胞癌, 经肝动脉化疗栓塞, 肝胆期, 结节信号强度, 磁共振动态增强扫描

Abstract: Objective To explore the value of magnetic resonance imaging (MRI) combined with dynamic contrast-enhanced MRI (DCE-MRI) perfusion quantitative parameters in evaluating the efficacy of transcatheter arterial chemoembolization(TACE) in hepatocellular carcinoma (HCC) during the hepatobiliary phase. Methods Retrospective analysis of the medical records of 86 HCC patients treated with TACE at Changzhou Third People's Hospital between January 2018 and January 2023. Record the MRI manifestations and DCE-MRI perfusion quantitative parameters of the hepatic and biliary phase donut nodules before transcatheter hepatic arterial chemoembolization treatment, including the vascular permeability constant (Kt), blood reflux constant (Kep), and percentage of extracellular space volume (Ve) at the maximum level of the lesion. After hepatic artery chemoembolization treatment, the efficacy was evaluated according to the solid tumor evaluation standard 1.1 (RECIST 1.1) and divided into stable group and progressive group. Analyze the influencing factors of the efficacy of TACE in HCC patients. Evaluate the predictive efficacy of MRI manifestations of hepatic biliary doughnut nodules and DCE-MRI perfusion quantitative parameters in predicting the efficacy of TACE in HCC patients. Results Among 86 HCC patients treated with hepatic artery chemoembolization, 46 (53.49%) progressed and 40 (46.51%) remained stable. Before undergoing hepatic arterial chemoembolization treatment, the MRI liver biliary phase scan results showed that among 86 HCC patients, 35 (40.70%) had hepatic biliary doughnut nodules, and the arterial phase showed high enhanced signal, with 45 (52.33%) showing low signal and 6 (6.98%) showing high signal. The sensitivity, specificity, positive predictive value, and negative predictive value of Pu Mei Xian's hepatic biliary phase donut nodule MRI in predicting the efficacy of TACE were 76.09%, 100.00%, 100.00%, and 78.43%, respectively. The ΔKt of patients in the progression group and stable group were (0.22 ± 0.07) and (0.31 ± 0.09), respectively, with ΔKep of (0.57 ± 0.12) and (0.39 ± 0.10). The △Kt of patients in the progressive group was lower than that in the stable group, while △Kep was higher than that in the stable group (P<0.05). There was no statistically significant difference in △Ve between the two groups (P>0.05). The total bilirubin (TBil), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels in the progressive group were higher than those in the stable group (P<0.05). TBil, ALT, AST, ΔKt, ΔKep, and the appearance of sweet doughnut nodules in the hepatobiliary phase of Pramiphene are risk factors for HCC progression (P<0.05). The MRI manifestations of the liver and gallbladder phase donut nodules in Pumeixian, as well as the AUC of single and combined prediction of HCC progression with △Kt and △Kep, were 0.880, 0.750, 0.748, and 0.887, respectively. Conclusion The MRI manifestations of Pumeixian hepatobiliary doughnut nodules and the changes in Kt and Kep during DCE-MRI perfusion are related to the treatment response of HCC patients to TACE, and can be used to predict the therapeutic effect.

Key words: Hepatocellular carcinoma, Transcatheter arterial chemoembolization, Hepatobiliary phase, Nodular signal intensity, Dynamic contrast-enhanced MRI

李云华, 高鑫阳. 普美显肝胆期甜甜圈结节MRI表现联合DCE-MRI灌注定量参数评估肝细胞癌经肝动脉化疗栓塞疗效的价值[J]. 肝脏, 2025, 30(2): 216-221.

LI Yun-hua, GAO Xin-yang. The value of combining the MRI manifestations of pumeixian liver bile stage donut nodules with DCE-MRI perfusion quantitative parameters in evaluating the efficacy of transcatheter arterial chemoembolization for hepatocellular carcinoma[J]. Chinese Hepatolgy, 2025, 30(2): 216-221.

/ 推荐

参考文献

[1] 杨凯仑, 李智, 任起梦, 等. 肝动脉化疗栓塞术不同化疗方案治疗原发性肝癌的疗效及安全性[J]. 实用医学杂志,2022,38(5):594-599.
[2] 徐宏伟, 孙德生, 徐惠亮, 等. 碳酸氢钠肝动脉灌注联合TACE治疗中晚期原发性肝癌的疗效观察[J]. 介入放射学杂志,2021,30(9):932-936.
[3] 李虎子, 段振东, 赵成, 等. TACE联合冷冻消融治疗不可切除肝癌临床疗效的meta分析[J]. 介入放射学杂志,2021,30(8):804-813.
[4] 翁炜, 吕秀玲, 张倩倩, 等. 基于磁共振影像组学技术对肝癌经肝动脉化疗栓塞术后短期疗效的预后价值分析[J]. 中华医学杂志,2020,100(11):828-832.
[5] 张继云, 张学琴, 张涛, 等. 基于钆塞酸二钠增强MRI联合微血管侵犯预测HBV相关HCC患者术后早期复发的价值[J]. 临床放射学杂志,2023,42(1):66-71.
[6] 陈莹, 张学琴, 冯峰, 等. 钆塞酸二钠增强MRI鉴别肝硬化背景下肝内胆管细胞癌和肝细胞癌的价值[J]. 实用放射学杂志,2023,39(5):759-763.
[7] 张桂荣, 张妍妍, 张博, 等. 普美显肝胆期甜甜圈结节MRI表现及其与结节信号胆汁淤积的关系[J]. 分子影像学杂志,2021,44(6):922-926.
[8] 邬政宏, 吴冬秋, 刘四斌. DCE-MRI诊断原发性肝癌效能和TACE术后评估肿瘤活性应用价值研究[J]. 实用肝脏病杂志,2022,25(6):881-884.
[9] 陈天佑, 袁敏, 周粟, 等. 3.0T动态增强磁共振灌注成像对小肝癌射频消融疗效评估的价值研究[J]. 介入放射学杂志,2022,31(2):154-159.
[10] 中国医师协会介入医师分会. 中国肝细胞癌经动脉化疗栓塞治疗(TACE)临床实践指南[J]. 介入放射学杂志,2018,27(12):1117-1126.
[11] Eisenhauer E A, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1)[J]. Eur J Cancer,2009,45(2):228-247.
[12] Maesaka K, Sakamori R, Yamada R, et al. Hypovascular hepatic nodules as a predictive factor for transcatheter arterial chemoembolization refractoriness in hepatocellular carcinoma[J]. Hepatol Res,2020,50(3):365-373.
[13] Liu C, Li T, He J T, et al. TACE combined with microwave ablation therapy vs. TACE alone for treatment of early- and intermediate-stage hepatocellular carcinomas larger than 5 cm: a meta-analysis[J]. Diagn Interv Radiol,2020,26(6):575-583.
[14] Kim J, Kim J Y, Lee J H, et al. Long-term outcomes of transarterial radioembolization for large single hepatocellular carcinoma: a comparison to resection[J]. J Nucl Med,2022,63(8):1215-1222.
[15] 田塬, 唐贵菊, 李波, 等. TACE联合局部消融术治疗不可切除原发性肝癌有效性与安全性的网状Meta分析[J]. 中国药房,2022,33(22):2779-2785.
[16] 王威, 周国锋. 影像学检查技术在评估肝癌TACE疗效方面的进展[J]. 临床放射学杂志,2021,40(6):1239-1242.
[17] 鲜明, 童欣, 张莉, 等. 多b值扩散加权成像联合DCE-MRI在小肝癌鉴别诊断中的应用[J]. 中国CT和MRI杂志,2021,19(5):56-58.
[18] 赵梦, 徐兴华, 王芳, 等. DCE-MRI减影技术及DWI序列在原发性肝癌局部介入术后评估的应用研究[J]. 医学影像学杂志,2020,30(3):414-419.
[19] Zech CJ, Ba-Ssalamah A, Berg T, et al. Consensus report from the 8th international forum for liver magnetic resonance imaging[J]. Eur Radiol,2020,30(1):370-382.
[20] Joo I, Kim SY, Kang TW, et al. Adiologic-pathologic correlation of hepatobiliary phase hypointense nodules without arterial phase hyperenhancement at gadoxetic acid-enhanced MRI: a multicenter study[J]. Radiology,2020,296(2):335-345.
[21] Kozaka K, Kobayashi S, Yoneda N, et al. Doughnut-like hyperintense nodules on hepatobiliary phase without arterial-phase hyperenhancement in cirrhotic liver: imaging and clinicopathological features[J]. Eur Radiol,2019,29(12):6489-6498.
[22] 马霄虹, 王爽, 赵心明, 等. 磁共振动态增强技术对肝细胞癌经导管肝动脉化疗栓塞疗效的预测和评估价值[J]. 中华肿瘤杂志,2017,39(9):689-694.
[23] 谢丽芬, 曹勃玲, 吴春晓, 等. 肝细胞癌IVIM和DCE-MRI定量评估及相关性分析[J]. 临床放射学杂志,2020,39(8):1511-1515.